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09110084 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11486 LINDY PL CONTRACTOR:SEARS HOME PERMIT NO:09110084 IMPROVEMENT 01"'NER'S NAME: EPSTEIN LAWRENCE A AND MONICA 1024 FLORIDA CENTRAL PKWY DATE ISSUED: 11/16/2009 C .4ER'S PHONE: 4089968995 LONGWOOD,FL 32750 PHONE NO:(925)245-2000 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG � ELECT� PLUMB License Class Lic.# 21 3 7 MECH RESIDENTIAL COMMERCIAL Contracto j I=j Date-].L— d I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:NEW KITCHEN COUNTERTOP/ADD 3 NEW (commencing with Section 7000)of Division 3 of the Business&Professions CIRCUITS/RECONNECT S/REC OUTLETS/UPGRADE(6)OUTLETS NEW TO F U CE 5 NEW Code and that my license is in full force and effect. CIRCUITS/RECONNECT NEW SINK&FAUCETS/CONNECT NEW 1 hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$1400 permit is issued. APPLICANT CERTIFICATION APN Number:35624008.00 Occupancy Type: I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Sianat �0 Date G U Issued tfc �<.-__ Date: ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,1 must Owner or authorized agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date:// APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is 1 hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name r the above mentioned property for inspection purposes.(We)agree to save nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18• I understand my plans shall be used as public records. Signature Date Licensed Professional J CITY OF CUPERTINO 9 ITEMS OF 14 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35624008 . 00 DATE ISSUED. . . . . . . : 11/16/2009 RECEIPT #. . . . . . . . . : BS000009200 REFERENCE ID # . . . : 09110084 SITE ADDRESS . . . . . : 11486 LINDY PL SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : EPSTEIN LAWRENCE A AND MONICA ADDRESS . . . . . . . . . . : 11486 LINDY PL CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4814 RECEIVED FROM . . . . : TOWN & COUNTRY PERM CONTRACTOR . . . . . . . : ALFRED W NYMAN JR - ASST SEC LIC # 23097 COMPANY . . . . . . . . . . : SEARS HOME IMPROVEMENT ADDRESS . . . . . . . . . . : 1024 FLORIDA CENTRAL PKWY CITY/STATE/ZIP . . . : LONGWOOD, FL 32750 TELEPHONE . . . . . . . . : (925) 245-2000 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 400 . 00 1 . 00 0 . 00 1. 00 0 . 00 1BPTRAP NO OF TRAPS 1 . 00 8 . 00 0. 00 8 . 00 0 . 00 1BREMRECEP NO. OUTLETS 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1BSEISMICR VALUATION 1, 400. 00 0 .50 0 . 00 0.50 0 . 00 1EPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00 1ERESAPPL NO OF APPLIAN 1 .00 21 . 00 0. 00 21. 00 0 . 00 1MPERMITFE FLAT RATE 1. 00 42 . 00 0. 00 42 . 00 0 . 00 1PPERMITFE FLAT RATE 1. 00 42 .00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 240 .50 0 .00 240 .50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 334 . 00 #1843 --------------- TOTAL RECEIPT 334 .00 CITY OF CUPERTINO Of CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM APN# — Date: Building Address:lZq L i/,Up Mailing Address (if different from buil ng address): Are Hazardous Materials being used as part of this project? Yes F1 No HOA: Exterior work only) Yes ❑ No C6 If Yes, provide letter from HOA _ Owner Name: Phone#• —��S W .t ri5 ) / Contractor: � Phone: Contractor License#: 7-�1 1; 2/ Cupertino Business License#: Contact: Phone: C.�D-5` 621C-e/ L Fax: Residentia >Q Commercial Fj Job Description: Nej,,1 kt T �'acfM6�d�D 1 O D 3 OJE1 Of G(�/�OGs (6 Ovl LC� 7�S c��! RO Building Permit Info: Bld -ff' Elect Plumb MecX Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B Valuation:$ L gIY4 0--� Square Footage: l� Project Size: Express ❑ Standard ;] Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicable, include in plan set& the sheet index. Points Achieved: For help, contact Build it Green at www.bufldit2reew.org Revised 07/14/09 CITY OF CUPERTINO Cin OF GENERAL BUILDING APPLICATION CUPEt�TINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) B additional stucco application 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1 WINMEWSTR New Window-structural shear B wall/masonry(includes plan ck fee) 1 EPERMITFEE Electrical Permit Fee E /I 1 MPERMITFEE Mechanical Permit Fee M r 1PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check(when no E/M/P) B when not over counter) hourly-stand alone 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT I TYPES / 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel &Documentation B 1BUSLIC Business License B r �s� PP 5 of 5 13 FP—r�� P 4511 Lhe 44213 •iT Ci3 831U1RB ryt#=Cj,j �j'$!h'. :i.�; �. �.:.,;i,.':.,:��. rg r r w fl -� GN - 19en m zr cri 00 �.. � , Fli r;103 ' Z r tee: `1 n 1•£962 t-I N.d ' Z m - ` � 6 G7 ` 1 r , ' § i m , o , t CT r •• i�p 'ter , r � C? � Y' o�D < °"`r a i � < 3 C 0 5,03 m 0 � z m �c \� Cz7c77 LP 2 �l CD a ° g y ° N o m O /V < o�� occaW z0 o Q ° c 'O 30 C '{ — 1 4 n 0 m Z _ (Ti -o -h o T zb R s •a � � C � \ � � Q7b C/i r-- - o sonz Z w u.F Community Development 10300 Torre Avenue - Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 XPEt�TINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: 1, w N PHONE # GENERAL CONTRACTOR: S FAX # I am not using any subcontractors: �c—2 Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets&Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock T i-I e- Owner/Eontiactor Signature Date